Avondale Mental Healthcare Centre

We found the following examples of good practice.

During the pandemic the provider installed a visiting pod near the entrance to the service. This pod enabled residents and their visitors to see each other with an intercom and glass door separation, which could be opened if appropriate and safe to do so.

Avondale Mental Healthcare Centre is a residential care home providing personal and nursing care to adults where their primary needs are associated with their mental health. They provide long-term placement, respite and rehabilitation for up to 54 people. There were 48 people using the service at the time of our inspection.

People’s experience of using this service and what we found

People were supported and encouraged to live enriched lives and to be as independent as possible. The highly diverse skills and knowledge across the senior staff and clinical leads had resulted in consistently better outcomes for people.

People spoke highly of the care and support they received and told us how their life had been significantly improved as a result. The development of people’s skills and abilities was paramount in the planning, assessing and delivery of care and support. The service was passionate about providing people with the tools needed to live a more independent life and move from Avondale in to more independent living.

Extremely effective relationships had been developed with other health and social care professionals resulting in significant improvements to people’s health and well-being. Professionals spoke highly of the standard of care people received and gave many examples of where lives had been positively impacted upon due to the excellent collaborative working.

Staff were provided with the skills they needed to deliver a high standard of care and spoke extremely highly of the training and support they received. The internal 'educator' was passionate about their role. Their continuous visibility and the various methods of training used meant that learning and development needs were quickly identified and addressed.

The excellent standard of learning and development had been extended to university students who also spoke highly of the training and support they received. Being an ‘accredited’ tutor meant that universities had confidence in the trainer's abilities to assess the work completed whilst the students were on work placement at Avondale.

The extremely positive relationships that had developed between staff and people resulted in positive impacts on people’s well-being. People spoke highly of the caring approach of all staff and told us how happy they were to be living at Avondale. They told us they felt listened to and respected by staff and could talk to them about any concerns they had. People told us their lives had got better because of the support staff gave them.

The leadership of the service demonstrated a high level of experience and capability to deliver excellent care; they were extremely knowledgeable and inspired confidence and passion in the staff team. The management team placed strong emphasis on developing people’s abilities and empowering then to become more independent.

People told us they felt safe living at Avondale and that staff were always around to help when they needed it. Staff knew how to recognise abuse and were confident in reporting any concerns. Risks to people had been assessed and detailed plans were in place to manage these whilst supporting people to live as unrestricted a life as possible.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff supported people to access a range of activities both within the home and in the community. Activities were used as a way to help develop people’s skills and independence and promote positive outcomes for people.

The service had been recognised by healthcare professionals for their advanced holistic approach to the planning of end-of-life care and the impact this had, both on people and family members.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: The last rating for this service was good (published 10 March 2017)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service had improved on the quality of care provided and has been rated outstanding overall.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Avondale Mental Health Care Centre offers support for up to 54 people whose needs are associated with their mental health. There were 45 people in residence on the day of our visit. Staff provides support for adults of all ages which included 24-hour long-term care, short-term care respite and assessment periods. Avondale is a purpose-built building, in a residential area of Whiston which is close to public transport routes.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection on the 23 and 29 of March 2016 there were five breaches of regulation in relation to people receiving person centred care and having their independence promoted, for suitable arrangements and documentation relating to consent of people living at the service to be in place and to ensure that care and treatment was provided in a safe way. The registered provider did not have suitable arrangements to assess and improve the quality of the service they provided and they did not have sufficient arrangements in place to ensure that the staff were suitably qualified, competent and skilled to meet the needs of the people living at the service. We asked the registered provider to take action to address these areas.

After the inspection, the registered provider sent us an action plan that specified how they would meet the requirements of the breaches identified. They advised us that they would meet all the legal requirements by August 2016. During this inspection we found that significant improvements had been made across all areas and the registered provider was able to demonstrate full compliance with the Health and Social Care Act 2008 (Regulated Activities) 2014.

The service had robust and safe recruitment practices in place. Appropriate checks were carried out before new staff started their employment. These checks ensured only staff suitable to work with vulnerable adults was employed. All new staff received a thorough induction which included a period of time shadowing experienced staff. Staff received regular training to ensure they remained up to date with their knowledge and skills required to their role. There was enough staff to meet the needs of the people living at the service.

Individual risk assessments were completed to ensure people and staff were protected from the risk of harm. Staff managed risk effectively and supported people’s decisions, so they had as much control and independence as possible.

All staff had received regular training in adult safeguarding and demonstrated a good understanding of how to recognise and report potential abuse. There were policies and procedures in place that informed staff of how to keep people safe and these were followed.

Staff had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Care records demonstrated people's involvement in decision making. Mental capacity assessments were completed as required by the MCA. Best interest meetings had taken place and were clearly documented with the decision making process clearly documented for people who lacked capacity.

Medicines were managed safely. Clear processes were in place that ensured people received their medicines on time and ‘as required’. Medicines were stored, administered and recorded in accordance with the registered provider’s policies and procedures.

People told us they had been involved in the development of their care plans. People’s care plans provided staff with clear direction and guidance as to how to meet their preferred needs. Care plans were regularly reviewed and updated. This meant people received person centred care.

People had enough to eat and drink. People who had been identified as at risk of weight loss or weight gain were weighed regularly. Records showed that a person was managing their diabetes through diet and they had their food and fluid intake clearly documented. This ensured people’s health and well-being was closely monitored and any changes were responded to promptly.

Daily records were completed and reflected on each area of the person’s care plan. Information included participation in people’s daily activities, medication administration, as well as any concerns relating to that individual.

People were supported to participate in activities of their choice. People told us they were treated with kindness and respect by staff. We observed positive interactions between staff and people living at the service.

People knew how to raise concerns and make complaints and felt confident to do so. People and their relatives believed any concerns or complaints would be dealt with promptly and to their satisfaction.

Quality assurance systems were in place that identified areas for improvement and development. Action plans evidenced areas that had been addressed in a timely manner. People’s feedback and ideas were actively sought from the management team and these were used for service development.

The management structure within the service provided clear lines of responsibility and accountability.

This was an unannounced inspection on the 23 March 2016 and 29 March 2016carried out by an Adult Social Care inspector, Specialist Advisor (SpA) for mental health and a bank inspector. During the inspection we spoke with nine people who lived at the service, 12 members of staff, a member of the board of directors, the registered manager and the registered provider. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found breaches of Regulations 9, 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered provider had not followed the requirements of the Mental Capacity Act 2005 (MCA). Staff were not provided with the correct instructions and did not demonstrate that they knew how to apply the Act to support people with making their own decisions.

Staff supervision was not always consistent at the service. Some of the staff we spoke with said they had not received supervision for some time.

People did not receive care and treatment that was safe and were at risk from care practices. Risks were not appropriately determined and actioned. We saw that physical needs such as the management of diabetes and wound care were not fully assessed, planned or monitored to ensure that physical needs were safely managed.

People told us that they had been included in the planning and had agreed to the care and support provided. We saw that people had a plan which outlined some of the ways staff were to support them. Risks were not always addressed in order to fully maintain the safety of people. The care and support provided centred around tasks and not the individual care needs of people living at the service. We saw that restrictive practice or intervention that limited peoples movements or support were not fully assessed to determine that they were justified.

Some of the systems used to assess the quality of the service had not identified the issues that we found during the inspection.

People told us that they were treated with kindness, compassion and respect. We saw positive interactions and observed that people enjoyed talking to the staff in the service. We observed that staff took the time to get to know people and supported them in undertaking activities. People told us they were able to see their friends and families whenever they wanted. We saw that there were arrangements in place to support people living in the service to access the community and maintain relationships with their families.

Systems were in place that supported and encouraged people to share their views of the service they received.

The staff told us they were aware of their responsibility to protect people from harm or abuse. They knew the action to be taken if they were concerned about the safety or welfare of an individual. They told us they would be confident in reporting any concerns to the management team.

The Care Quality Commission has a duty to monitor activity under the Deprivation of Liberty Safeguards (DoLS). The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. The service had made DoLS applications as required.

Significant improvements had been made in the management of medicines. People received their medicines as they were prescribed for them.

During the Inspection visit we observed that all the staff interacted with people living at the service in a calm and confident manner, we saw how this approach helped to reduce people's challenging behaviours. We also found that the staff encouraged people to be respectful to each other and this also helped to reduce people's challenging behaviours.

We found that people living at Avondale were well cared for. We also found that the staff working at the service had undergone robust recruitment checks prior to starting work at the service to ensure the safety of people living at the service. We noted that there were sufficient numbers of staff on duty.

We found that records relating to care were clear, person centred, detailed securely stored and fit for purpose. Records relating to the staffing and management of the service were accurate and fit for purpose.